Introduction and purpose: The rupture of the anterior cross ligament (ACL) is the most frequent knee injury incurred during participation in sports and especially in football. Typically, the injured ... [more ▼]

Introduction and purpose: The rupture of the anterior cross ligament (ACL) is the most frequent knee injury incurred during participation in sports and especially in football. Typically, the injured athlete must undergo a surgical reconstruction of the ligaments followed by a lengthy rehabilitation period. However, the timeline for return to competition after this operation remains a challenge. More than one third of the athletes are unable to go back to sport performing at the same level prior to the injury. Approximately 65% of patients who experience this injury are able to return to sport at the same level. The fear of undergoing a new accident remains a major hurdle with this sporting recovery and the persistence of functional deficits is the first cause of repetitive ligament injuries. A reathletization program guided by strength and conditioning coaches results in a greatly reduces the risk of recurring injury by approximately 66% Methods: Our study involved a randomized control test. Our sample included ten subjects, five in the experimental group and five in the control group. Beginning one month post-surgery, the first group participated in weekly reathletization session beginning one week post-operation, associated with rehabilitation in classical physiotherapy, over a period of six months. The second participated solely in standard physiotherapy. Both groups were subjected to an initial isokinetic test as a base measurement to track improvement. After six months, the subjects of the two groups were evaluated using the following tools: an isokinetic test, a questionnaire of KOOS and finally a Hop tests. Results: The analysis of the isokinetic test and the questionnaire of KOOS ( p= 0.30) enabled us to note differences between the two groups using quantified values; however, the results were significant. On the other hand, the analysis of the results obtained through the functional tests showed significant differences between the two groups, highlighting the increased performance and benefit for the group participating in weekly reathletization. The experimental group displayed results in the three jump tests which indicates a greater strength and recovery. For the single hop test and the triple hop, the result is p = 0.04, and for the cross over test, the result is p = 0.02. Conclusion: In our preliminary study, the quantified values for both groups indicated a greater improvement in the performances of the experimental group reathletization. Although during the statistical analysis and especially in the isokinetic test, few elements significantly evolved to see any for the questionnaire KOOS. The preliminary analysis warrants an experiment involving a larger subject pool be completed. A reathletisation program beginning one month after operation has been found to limit the nuisances and long period of inactivities (weight increase, losses of muscular force, decrease of aerobic performances) typically experienced by those who rupture the ACL. This program has been found to be especially effective when coupled with regular physiotherapy meetings. [less ▲]

Injuries to the anterior cruciate ligament (ACL) of the knee are disabling, often associated with other intra-articular damages and increase the risk of early onset of osteoarthritis. It is very probable ... [more ▼]

Injuries to the anterior cruciate ligament (ACL) of the knee are disabling, often associated with other intra-articular damages and increase the risk of early onset of osteoarthritis. It is very probable that multiple risk factors act in combination to influence injury risk. It is important to have a comprehensive understanding of these ACL risk factors, whose neuromuscular factors, even if investigations on neuromuscular factors reported to date do not provide a complete understanding of ACL injury risk. According to several recent studies, the neuromuscular control of joint biomechanics during a specific activity seems to represent a predicting factor of an ACL injury, by quantifying the intersegmental forces and moments generated about the tibio-femoral joint. Laboratory studies have shown that landing from a jump performs cutting and pivoting maneuvers with less knee and hip flexion, increases knee valgus and internal rotation of the hip coupled, with increased external rotation of the tibia and quadriceps muscle activation (especially in women). It has been hypothesized that these movement patterns increase the strain in the ACL during activity and that the large difference in knee injury incidence rates between males and females (1/4.5) may be attributed to neuromuscular differences and resultant mechanics. Although studies have shown that the position of the knee and the magnitude and sequence of muscle contraction can increase ACL strain values, it is hard to exactly correlate these movements to what occurs during activity and sport and at the time of ACL injury. Recently, a simpler assessment tool has been validated and is able to be administered in a clinic-based testing environment Consequently, the screening for ACL injury risk could be performed on a more widespread population. Athletes who went on to a primary ACL injury also demonstrated significant side to side differences in lower extremity biomechanics as well as reduced relative lower extremity flexor activation relative to an uninjured control population during the vertical drop jump. Similar mechanisms of injury risk have been identified in athletes medically cleared to return to sport after ACL reconstruction. These seminal findings indicate that these abnormal and asymmetrical biomechanical and neuromuscular control profiles are likely both residual to, and exacerbated by, the initial injury. A study revealed that a fatigue-induced protocol altered the latency as well as the magnitude of reflex responses of the hamstring muscles and the tibial translation only in women. The authors of various studies have suggested that the hamstring muscles play an important role in maintaining knee stability and that they protect the ACL during movements of the tibia relative to the femur. Therefore, decreased reflex responses of the hamstring muscles and in turn an increased the tibial translation might contribute to the pathomechanics of the ACL injuries. It is therefore conceivable that the fatigue-induced decrease of the hamstring neuromuscular function may increase the tibial translation and probably contributes to the higher incidence of ACL injuries, especially in women. A preventive approach to decrease ACL injuries could integrate muscle imbalances as a risk factor. If it has been scientifically validated than the muscle strength profile determined by an isokinetic testing offers a predictive value on the hamstring lesion occurrence, similar studies have not permitted such a conclusion about ACL injury. The isokinetic assessments after ACL reconstruction have allowed us to observe, on the healthy contralateral knee, a higher frequency of reduced hamstring/quadriceps ratios. A possible pre-existing weakness in the hamstring and the occurrence of an ACL injury is therefore possible but only a difficult prospective approach due to the multifactorial nature of ligament injuries could clarify that point. In conclusion, a functional analysis of the landing of a jump and an isokinetic muscle strength assessment have been suggested to represent predictive elements of an ACL rupture, but further studies are needed to have a stronger evidence of their predictive qualities of injury. [less ▲]

Background: Upper patellar tendinopathies remain often chronic and rebel to a thorough conservative treatment. Moreover, the option of a surgical treatment could be disappointing. New treatments are being ... [more ▼]

Background: Upper patellar tendinopathies remain often chronic and rebel to a thorough conservative treatment. Moreover, the option of a surgical treatment could be disappointing. New treatments are being developed. Injection of PRP is one of these. Platelets contain lot of growth factors which would have the potentiality to enhance the healing process of tendons. Even if in vitro and animal experiments have demonstrated this stimulation of tendon healing process1, clinical series are subject to controversy2. Methods: Twenty patients with chronic upper patellar tendinopathy were enrolled. Assessments ［VAS, clinical examination with an algometer, algofunctional scores (IKDC and VISA-P), functional assessments (isokinetic and Optojump) and imagery (ultrasounds and MRI)］were made before infiltration of PRP, and 6 weeks and 3 months after. The PRP was obtained by an apheresis system (COM.TEC, Fresenius). Six millilitres of PRP were injected without local anaesthetic. One week after infiltration, patients started a 6-week standardised sub-maximal eccentric reeducation. Results: We observed a very significant improvement of the algofunctional status as soon as 6 weeks after the infiltration of PRP, and continued to a lesser extent up to 3 months. During functional evaluation, pain decreased as well, but without significant improvement of performances. No significant improvements in the imagery were observed. Interestingly, patients who had a VAS equal or below 1 after 3 months post-infiltration were younger (24.7 vs 32.2 y.o.). Moreover, these younger patients had a significant increase of the IKDC score (p=0.003), a significant improvement of pain during isokinetic evaluations (p<0.05), and during Optojump assessments (p=0.01). Seventy-five percent of subjects were able to return to sport, even if only half of these patients recovered the same level than before the tendinopathy. Discussion / Conclusions: This study demonstrates that a local infiltration of PRP associated with a submaximal eccentric protocol is efficient to improve symptoms of chronic upper patellar tendinopathies, non-responsive to classical conservative treatments. However, up to now, there is no consensus on the method to prepare the PRP. Indeed, each technique could provide a very different PRP (variations in the platelet concentrations and of the amount of red and white cells). [less ▲]

Introduction: Tendinopathies, especially jumper’s knee, often remain rebel to conservative treatments. Several experimental studies have shown the healing properties of platelet and their growth factors. Researches have specifically demonstrated the platelets action as mediator and/or enhancer of tissue healing. The aim of our study was to investigate the effect of 1 injection of PRP in patients suffering from chronic jumper’s knee. Our protocol was approved by Ethic Committee of University and University Hospital of Liège. Methods: Patients performed imaging (US and MRI) and functional assessments, and a clinical examination using an algometer, before treatment and 6 weeks after PRP treatment. They were also invited to answer to questionnaire relative to pain and functional status. PRP was obtained from autologous blood using an apheresis system (COM.TEC, Fresenius). The injection of 6mL of PRP was realised without local anaesthesia into the proximal insertion of the patellar tendon. A 48h rest-time was recommended after infiltration. Afterwards, a submaximal eccentric reeducation was initiated 1 week after infiltration 3 times a week during 5 weeks. In case of pain, anti-inflammatory drugs were prohibited and patient were encouraged to take class I or II painbrakers. Results: At this time, 10 patients with jumper’s knee were included in our study. Pre-injection tests revealed pain of the upper part of the patellar tendon just below the patella, associated with loss of function. Imaging exams confirmed diagnosis. Six weeks post-injection, the clinical status was improved in all patients, with a significant decrease of algo-functional scores. The pain reported during functional assessments was decreased (in particular for the eccentric actions), yet no significant improvement of physical performances was observed. We found no significant differences between imaging exams before and 6 weeks after PRP injection. Conclusion: One in situ injection of PRP clinically improved patients with jumper’s knee 6 weeks after treatment. All the 10 patients reported a decrease of pain during day-life and through physical activities. However nor functional performances neither imaging were improved. [less ▲]